Prognostic value of dynamic hypoxia PET in head and neck cancer: Results from a planned interim analysis of a randomized phase II hypoxia-image guided dose escalation trial. Issue 3 (September 2017)

• Record Type: Journal Article
• Authors: Welz, Stefan; Mönnich, David; Pfannenberg, Christina; Nikolaou, Konstantin; Reimold, Mathias; La Fougère, Christian; Reischl, Gerald; Mauz, Paul-Stefan; Paulsen, Frank; Alber, Markus; Belka, Claus; Zips, Daniel; Thorwarth, Daniela
• Is Part Of: Radiotherapy and oncology. Volume 124:Issue 3(2017:Sep.)
• Page Start: 526
• Page End: 532
• Publication Date: 2017-09
• Subjects: Hypoxia -- Head and neck cancer -- IMRT -- Dose escalation -- FMISO PET/CT; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2017.04.004
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: To prospectively assess the prognostic value of tumour hypoxia determined by dynamic [ 18 F]Fluoromisonidazole (dynFMISO) PET/CT, and to evaluate both feasibility and toxicity in patients with locally advanced squamous cell carcinomas of the head and neck (LASCCHN) treated with dynFMISO image-guided dose escalation (DE) using dose-painting by contours. Patients and methods: We present a planned interim analysis of a randomized phase II trial. N = 25 patients with LASCCHN received baseline dynFMISO PET/CT to derive hypoxic volumes (HV). Patients with tumour hypoxia were randomized into standard radiochemotherapy (stdRT) (70 Gy/35 fractions) or DE (77 Gy/35 fractions) to the HV. Patients with non-hypoxic tumours were treated with stdRT. Loco-regional control (LRC) in hypoxic patients randomized to stdRT was compared to non-hypoxic patients. Feasibility and toxicity were analysed for patients in the DE arm and compared to stdRT. Results: With a mean follow-up of 27 months, LRC in hypoxic patients receiving stdRT ( n = 10) was significantly worse compared to the non-hypoxic group ( n = 5) (2y-LRC 44.4% versus 100%, p = 0.048). The respective LRC for the DE group ( n = 10) was 70.0%. Treatment compliance as well as acute and late toxicity did not show significant differences between the DE and the standard dose arms. Conclusion: Tumour hypoxia determined by baseline dynFMISO PET/CT is associated with a high risk of local failure in patients with LASCCHN. First data suggest that DE to HV is feasible without excess toxicity.